Bariatric Surgery treat severe obesity

There are many reasons to lose weight and maintain a healthy lifestyle. Some people have serious health concerns. Others want to feel better about their appearance. Many are simply tired of the burden of being overweight and want to improve their daily quality of life.

Weight loss surgery is a life-altering decision — one of the most important decisions a person will ever make. With that in mind, we've pulled together the information you need about obesity, weight loss surgery, making the choice, finding a surgeon, life after surgery, and additional resources to help in the decision-making process.

Bariatric Surgery is an effective alternative to treat severe obesity. Only people who suffer from morbid obesity (body mass index higher than 40) can have bariatric procedures.

WHAT IS MORBID OBESITY ?


Medically, the word "morbid" means causing disease or injury. Morbid Obesity is a serious disease process, in which the accumulation of fatty tissue on the body becomes excessive, and interferes with, or injures the other bodily organs, causing serious and life-threatening health problems, which are called co-morbidities.

Obesity becomes "morbid" when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases, also known as co-morbidities. These co-morbidities are conditions or diseases that result in either significant physical disability or even death. As you read about morbid obesity you may also see the term "clinically severe obesity" used. Both are descriptions of the same condition and can be used interchangeably. Morbid obesity is typically defined as being 100 lbs. or more over ideal body weight or having a Body Mass Index of 40 or higher. Morbid obesity is a serious disease and must be treated as such. It is a chronic disease, meaning that morbid obesity symptoms build slowly over an extended period of time.

HEALTH EFFECTS OF MORBID OBESITY

Severe obesity damages the body by its mechanical, metabolic and physiological adverse effects on normal bodily function. These "co-morbidities" affect nearly every organ in the body in some way, and produce serious secondary illnesses, which may also be life-threatening. The cumulative effect of these co-morbidities can interfere with a normal and productive life, cause endless frustration and can seriously shorten life, as well.

Shortened Life Span

Dysmetabolic Syndrome X
This recently recognized syndrome, involving abdominal obesity, abnormal blood fat levels, changes in insulin sensitivity, and inflammation of the arteries, is assciated with a markedly increased risk of heart and blood vessel disease. It is also a precursor to the onset of Diabetes in adults.

Heart Disease
Severely obese persons are approximately 6 times as likely to develop heart disease as those who are normal-weighted. Heart disease is the leading cause of death in the world today, and obese persons tend to develop it earlier in life, and it shortens their lives. Coronary disease is pre-disposed by increased levels of blood fats, and the metabolic effects of obesity. Increased load on the heart leads to early development of congestive heart failure. Severely obese persons are 40 times as likely to suffer sudden death, in many cases due to cardiac rhythm disturbances.

High Blood Pressure
Essential hypertension, the progressive elevation of blood pressure, is much more common in obese persons, and leads to development of heart disease, and damage to the blood vessels throughout the body, causing susceptibility to strokes, kidney damage, and hardening of the arteries. If your doctor finds you have high blood pressure, the first thing he or she will recommend to you is weight loss (but doctors have never been able to tell us how).

High Blood Cholesterol
Cholesterol levels are commonly elevated in the severely obese -- another factor predisposing to development of heart and blood vessel disease. This abnormality is not just related to diet, but is an effect of the massive imbalance in body chemistry which obesity causes.

Diabetes Mellitus
Overweight persons are 40 times as likely to develop Type II, Adult-Onset, Diabetes. Elevation of the blood sugar, the essential feature of Diabetes, leads to damage to tissues throughout the body: Diabetes is the leading cause of adult-onset blindness, a major cause of kidney failure, and the cause of over one half of all amputations. Diabetics suffer severely from their disease, and once Diabetes occurs, it becomes even much harder to lose weight, because of hormone changes which cause the body to store fat even more than before.

Sleep Apnea Syndrome
Sleep apnea -- the stoppage of breathing during sleep -- is commonly caused in the obese, by compression of the neck, closing the air passage to the lungs. It leads to loud snoring, interspersed with periods of complete obstruction, during which no air gets in at all. The sleeping person sounds to an observer like he is holding his breath, but the sleeper is, himself, usually unaware that the problem is occurring at all, or only notices that he sleeps poorly, and awakens repeatedly during the night. The health effects of this condition may be severe, high blood pressure, cardiac rhythm disturbances, and sudden death. Affected persons awaken exhausted and often fall asleep during the day -- sometimes even at the wheel of their car, and complain of being tired all the time. This condition really has a high mortality rate, and is a life-threatening problem.

Obesity Hypoventilation Syndrome
This condition occurs primarily in the very severely obese -- over 350 lbs. It is characterized by episodes of drowsiness, or narcosis, occurring during awake hours, and is caused by abnormalities of breathing and accumulation of toxic levels of carbon dioxide in the blood. It is often associated with sleep apnea, and may be hard to distinguish from it.

Respiratory Insufficiency
Obese persons find that exercise causes them to be out of breath very quickly, during ordinary activities. The lungs are decreased in size, and the chest wall is very heavy and difficult to lift. At the same time, the demand for oxygen is greater, with any physical activity. This condition prevents normal physical activities and exercise, often interferes with usual daily activities, such as shopping, yard-work or stair climbing, making even ordinary living difficult or miserable, and it can become completely disabling.

Heartburn - Reflux Disease and Reflux Nocturnal Aspiration
Acid belongs in the stomach, which makes it to help digest your food, and it seldom causes any problem when it stays there. When it escapes into the esophagus, through a weak or overloaded valve at the top of the stomach, the result is called "heartburn", or "acid indigestion". The real problem is not with digestion, but with the burning of the esophagus by the powerful stomach acid, getting to where it doesn't belong.. When one belches, the acid may bubble up into the back of the throat, causing a fiery feeling there as well. Often this occurs at night, especially after a large or late meal, and if one is asleep when the acid regurgitates, it may actually be inhaled, causing a searing of the airway, and violent coughing and gasping.

This condition is dangerous, because of the possibility of pneumonia or lung injury. The esophagus may become strictured, or scarred and constricted, causing trouble with swallowing. Approximately 10 - 15% of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett's esophagus, which is a pre-malignant change in the lining membrane of the esophagus, a cause of esophageal cancer.

Asthma and Bronchitis
Obesity is associated with a higher rate of asthma, about 3 times normal. Much of this effect is probably due to acid reflux (described above), which can irritate a sensitive airway and provoke an asthmatic attack. The improvement of asthma after surgery is often very dramatic, even before much weight loss has occurred.

Gallbladder Disease
Gallbladder disease occurs several times as frequently in the obese, in part due to repeated efforts at dieting, which predispose to this problem. When stones form in the gallbladder, and cause abdominal pain or jaundice, the gallbladder must be removed.

Stress Urinary Incontinence
A large heavy abdomen, and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing. This condition is strongly associated with being overweight, and is usually relieved by weight loss.

Degenerative Disease of Lumbo-Sacral Spine
The entire weight of the upper body falls on the base of the spine, and overweight causes it to wear out, or to fail. The consequence may be accelerated arthritis of the spine, or "slipped disk", when the cartilage between the vertebrae squeezes out. Either of these conditions can cause irritation or compression of the nerve roots, and lead to sciatica -- a dull, intense pain down the outside of the leg.

Degenerative Arthritis of Weight-Bearing Joints
The hips, knees, ankles and feet have to bear most of the weight of the body. These joints tend to wear out more quickly, or to develop degenerative arthritis much earlier and more frequently, than in the normal-weighted person. Eventually, joint replacement surgery may be needed, to relieve the severe pain. Unfortunately, the obese person faces a disadvantage there too -- joint replacement has much poorer results in the obese, and complications are more likely.. Many orthopedic surgeons refuse to perform the surgery in severely overweight patients

Venous Stasis Disease
The veins of the lower legs carry blood back to the heart, and they are equipped with an elaborate system of delicate one-way valves, to allow them to carry blood "uphill". The pressure of a large abdomen may increase the load on these valves, eventually causing damage or destruction. The blood pressure in the lower legs then increases, causing swelling, thickening of the skin, and sometimes ulceration of the skin. Blood clots also can form in the legs, further damaging the veins, and can also break free and float into the lungs -- called a Pulmonary Embolism -- a serious or even fatal event.

Emotional/Psychological Disease
Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, and cannot enjoy theatre seats, or a ride in a bus or airliner. There is no wonder, that anxiety and depression might accompany years of suffering from the effects of a genetic condition -- one which skinny people all believe should be controlled easily by will power.

Social Effects
Seriously obese persons suffer inability to qualify for many types of employment, and discrimination in employment opportunities, as well. They tend to have higher rates of unemployment, and a lower socioeconomic status. Ignorant persons often make rude and disparaging comments, and there is a general societal belief that obesity is a consequence of a lack of self-discipline, or moral weakness. Many severely obese persons find it preferable to avoid social interactions or public places, choosing to limit their own freedom, rather than suffer embarassment.

Deciding to have weight loss surgery can be difficult. But for many obese people, it offers a treatment option that can lead to a healthier life. Weight Loss Surgery Options provides you with an introduction to obesity surgery and explains who qualifies for weight loss surgery.

Many obese people are turning to stomach surgery to help them get on the road to a healthier life. Learn about the different procedures doctors are performing for weight loss

Benefits of Bariatric Surgery


The benefits of this surgery are more than skin deep. Baraitric Surgery will not only help you look better; more importantly, with proper post-surgical care, it will help you feel better and healthier.

Most patients lose at least 50 per cent of excess body weight. Most people with hypertension and/or diabetes no longer need medications.

A return to normal periods for young women with abnormal or absent menses and improvement of fertility. Improved sexual function for many males. Reduction of periods of sleep apnea. Eliminates or slows the disabling effects of arthritis. Improved self-esteem and more energy.

PROCEDURES FOR OBESITY SURGERY

Different types of surgery for treating Obesity or Surgical Operations for Morbid Obesity

The Laproscopic Adjustable Gastric Banding


The band is placed laparoscopicaly "key hole surgery".The band can be adjusted by injecting fluid into it as an outpatient.Reversible Hospital stay 2-3 days

In this procedure a band made of silastic material is placed around the stomach near its upper end creating a small pouch and narrow passage into the larger remainder of the stomach.

The surgery involves forming a small pouch in the upper part of the stomach that effectively becomes a new baby stomach. The sialistic band is wraped around the upper portion of stomach all around to form a "baby stomach." The narrow opening or stoma is formed by the bands two ends joining together. This band has a balloon on it which can be inflated or deflated in later stages so as to increase or decrease the size of stoma. This step makes the SAGB a stoma adjustable operation. This can be done anytime after the operation with the help of port kept under the skin at the time of operation, Now the food still goes down the normal way and is digested in the bowel normally. The big difference is that the pouch will only allow a very small amount to be fitted in at one time and when this happens satisfaction is achieved and hunger will subside until the pouch eventually empties into the duodenum. So you feel full after eating a small amount of solid food and your intake of food can be kept to two or three tiny meals a day with no desire to eat between meals.


Advantages of The Laproscopic Adjustable Gastric Banding

There are several weight loss surgeries available today but adjustable Gastric Band is superior to many of them. It has several features that make it the safest method of weight control.

* Simplicity - The procedure is simple to perform with a short operating time.
* It can be placed laparoscopically without a large incision.
* It does not require any opening in the gastrointestinal tract that reduces the risk of infection.
* Safety: There is no staple line to burst.
* It is adjustable and can be customised to individual needs.
* It is fully reversible. The band can be emptied, for example, during pregnancy or prolonged illness allowing your stomach to return to former configuration or it can be removed (although removal is not indicated)
* It is tolerated well by most persons of all ages and physical conditions.
* This operation may be particularly suited to persons who are from 80 to 200 pounds overweight.
* Short hospital stay (around 24 hours)
* Lowest complication rate.
* There is no mal-absorption or "dumping syndrome." The person can fully digest vitamins and minerals

Frequently Asked Questions for Laproscopic Adjustable Gastric Banding


Who is a Good Candidate for Adjustable Gastric Banding?

You may be eligible for the lap band system surgery if :

* Your BMI is =40, or you weigh twice your ideal weight or are at least 100 pounds (45Kgs.) more than your ideal weight.
* You have been overweight for more than 5 years
* Your serious weight loss attempts have had only short-term success.
* You are not suffering from any other diseases that may have caused your obesity.

How much weight will I lose?

This is not predictable; most of the patients will never be skinny people. But the majority can and do achieve a normal, healthy weight for their height and bone structure. Success after bariatric surgery is defined as losing 50 percentage of excess body weight. After a Laparoscopic Adjustable Gastric Banding, one loses an average 60 percentage of excess body weight at 18 months.

With both these options, how do I choose the right one?

After educating yourself to all the aspects of these operations you can decide with your surgeon which is the best operation. Both the operations can be performed laparoscopically in almost everyone.

The Lap-Band requires significant post-operative manipulation, has a re-operative rate that is high, but is the simplest procedure to perform. The Lap-Band probably has the lowest average weight loss and is a much slower weight loss than the other operations. The operative mortality is the lowest of all the procedures. There are occasional patients that do not lose significant weight after this operation

The gastric bypass is the most studied of all the bariatric operations. It is generally a safe and effective operation. There is a higher early complication rate than the Lap-Band.

Is it true that I'll never be able to enjoy eating again if I have weight control surgery?

No. Patients who follow the guidelines to eating after weight control surgery will become people who eat food for quality and flavor, not for volume. They enjoy food more after surgery than they did before surgery. They pay more attention to what they are eating, are often pickier eaters, and don't feel guilty about eating food.

Are there foods I can no longer eat?

You will be on a liquid diet at first progressing to a soft diet then to solids for the six-week healing phase. When properly adjusted, there are some foods that no longer are as easy to eat but most of bandsters can eat anything, just very small amounts. One can have trouble with soft mushy breads, tough or dry meats, skins of certain fruits or vegetables such as grapes, potatoes and tomatoes or very fibrous foods like asparagus or pineapple.
What should I be eating?
A. Protein and produce, if it isn't one of those two items then it is something that should not be part of your daily diet. Chicken and vegetables, Beef and vegetables, Fish and vegetables, some fruit thrown in there and a little dairy and you are good to go!.

Can I drink alcohol or soda pop?

Alcohol is not a good idea because it is a stomach irritant and is high in calories. It is always better to consume solid food with daily 1200 calories rather than drink them. However, one can have a drink occasionally. Beer, soda pop or any carbonated beverage is not recommended because of the potential to stretch your pouch. You may find the carbonation very uncomfortable after you are properly adjusted. However an occasional (once a week) drink may be consumed in moderation.

What if I go out to eat?

Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions.

When I reach my goal weight do I need to remove my band?

No, most of the patients plateau with weight loss when they get close to a normal weight and stop losing. If you continue to lose beyond your ideal weight, some of the fluid may be removed from your band to stabilize your weight. Most banded people regain most if not all of their excess weight if the band is removed.

If I get pregnant will I be able to get enough nutrition for my baby?

Many patients have become pregnant after both gastric bypass and the Lap-Band procedure. In fact, several studies have demonstrated that significant weight loss can improve fertility and one recent, excellent study from Australia showed that weight loss after the Lap-Band improves fertility in morbidly obese women. There is also a syndrome called Polycystic Ovary Syndrome (PCOS), which can lead to infertility. This syndrome involves excessive hair growth and hormonal changes that generally resolve with dramatic weight loss after bariatric surgery. As far as getting enough appropriate nutrition to have a safe pregnancy, this has not been a demonstrated problem with either the Lap-Band or the gastric bypass. However, you are recommended to consult with your bariatric program nutritionist to be safe if you do get pregnant.


What are the short term and long term dietary restrictions after banding?

First week post-op: you will typically be on a full liquid diet. Second week post-op: you will typically eat puree/soft foods diet. High calorie liquids should be avoided after the liquid stage. Other than that, it depends on individual tolerances.
Gastric Bypass


Gastric pouch 30 ml. Part of small intestine is bypassed. Greater weight loss. Hospital stay 5-7 days Vitamin mineral supplementation required.

In this procedure a small stomach pouch is created by stapling the stomach. This causes restriction of the food intake. Next a "Y" shaped section of the small intestine is attached to the pouch to allow food to by-pass the first part of small intestine. This causes reduced calorie and nutrient absorption.

Advantages of Laproscopic Gastric Bypass RNY

* After gastric bypass surgery, weight loss is more predictable and usually maintained. Average excess weight loss is usually higher than with purely restrictive procedures.
* One year after surgery, weight loss can average 65% to 70% of excess body weight. After 10 to 14 years, some patients have maintained 50-60% of excess body weight loss.
* 96% of certain associated health conditions (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved according to a 2000 study of 500 patients. It also helps in leg swelling, high cholesterol, urinary incontinence etc.

Sleeve Gastrectomy


With this procedure, the surgeon removes approximately 60 per cent of the stomach laparoscopically so that the stomach takes the shape of a tube or "Sleeve".

Technically most of these procedures are reversible but it is not advisable to contemplate reversal as person can regain the loss weight. Band slippage incidence has reduced with the modified band placement technique, improved band design and standardization of band adjustment protocol.

Bariatric surgery continues to benefit people struggling with morbid obesity, most importantly it saves lives. But finally it is you who has to remember that "health is the thing that makes you feel that now is the thing that makes you feel that now is the best time of the year!!"
Frequently Asked Questions for GASTRIC BYPASS


How do I know if I qualify for weight reduction surgery

You qualify if:

* You weigh twice your ideal body weight or You are overweight by 100 lbs or more
* You have a BMI (body mass index) more than 40 or
* You have a BMI more than 35 with co-morbidities (illnesses related to being overweight).
* You are overweight for 5 years or more
* You have failed to lose weight or sustain weight loss under supervision
* You are willing to comply with lifestyle and diet changes


Will I have to stop smoking?

Patients are encouraged to stop smoking at least one month before surgery. Smoking increases the risk of lung problems and can reduce the rate of healing. It increases the rate of incisional hernia and leaks by interfering with the blood supply of healing tissues.

How long will I stay in the hospital?

As long as it takes to be self-sufficient. Although it can vary, hospital stay (excluding the day of surgery) can be 3 to 4 days for a laparoscopic gastric bypass, and 5-7 days for an open gastric bypass. After leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.
How soon can I drive?

For your own safety, you should not drive until you are no longer taking narcotic medication for pain and can respond quickly to traffic. Usually this takes 7-14 days after surgery.

What will I eat after surgery?

You will be on intravenous fluids on the day of surgery. The day after we may do a swallow study to be sure there is no leak in the staple line. If there is no leak, you will be started on liquid diet 24 to 48 hours after surgery. Intake is limited to 1 or 2 ounces per meal so that the stomach can heal properly. If this is well tolerated, next day you will be advanced to blanderised soup. You will be discharged on liquid diet. We begin patients with liquid diets, moving next to semi-solid foods and about 4 to 6 weeks later, back to solid foods. This transition is necessary to allow time for your newly created stomach pouch to heal properly. Drink 2 liters or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.

What happens to the lower part of the stomach that is bypassed?

The stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food. It still produces the secretion necessary to absorb Vitamin B12 and contributes to endocrine hormonal balance and motility of the intestines in ways that are not entirely understood.

What if I am really hungry?

This is usually caused by the types of food you may be consuming, especially starches (rice, pasta and potatoes). Increasing protein intake is helpful. There may also be a psychological problem with lack of food in your life "head hunger". Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch.
Is sexual activity restricted?

Patients can return to normal sexual intimacy when wound healing and discomfort permit.

I am thinking about getting pregnant. Will I be able to have children after weight loss surgery?

Many women have had successful pregnancies after weight loss surgery. There is nothing per se that would prevent pregnancy. Infact, bariatric surgery enhances fertility in those who have had difficulty in conceiving. We recommend, however, that you wait until your weight loss is complete before becoming pregnant. This may take a year or more. The effect of rapid and prolonged weight loss on the developing fetus is unknown but it could have dire consequences and pregnancy is not recommended until a stable weight has been attained.

What can I do to prevent excess hanging skin?

The amount of excess skin depends on the age, skin elasticity, total weight loss and how much the skin was stretched. Many people, heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back". Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight.

Will exercise help with excess hanging skin?

Exercise is good in so many other ways that a regular exercise program is recommended. Unfortunately, most patients may still be left with flaps of loose skin.

What will my long term diet be like ?

* Eat three small meals a day.
* Keep a record of your dietary intake. Include everything you eat and drink: the date, time and amount of each meal. Start keeping this record (food diary) from one week after the surgery so if you begin having problems with vomiting, diarrhea or malabsorption. we can review your food record and make recommendations.
* Not only is there an adjustment to make about the quantity but also quality of food you should eat. When you are able to eat solid foods again, eat food high in protein. Protein foods are very important for the healing of staple line of your pouch. Protein in the form of lean meats (chicken, turkey, fish) and other low-fat sources should be eaten first. These should comprise at least half the volume of the meal eaten. Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods. Hair loss is one effect of not eating enough protein.
* You will also have to learn to eat slowly and chew your food thoroughly. Food not chewed properly will not pass through the narrow stoma and may cause vomiting.
* Stop eating as soon as you feel full. If you do not stop, you may have vomiting and it will put strain on the staple line.
* Do not eat sweets! This includes sweetened chewing gum, candy and regular sodas. Beware of hidden sweets (cereals with honey or sugar coatings).
* You may be unable to tolerate certain foods, especially those containing fat and sugar. A balanced diet of 1000 – 1200 calories a day is recommended.
* Drink 2 liters or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.
* Never drink water or any fluid with the meal. Drink fluids thirty minute to an hour after meals. Taking fluids before or at meal time may cause bloating, low food intake, vomiting, or dumping syndrome. It will also flush the food through the stoma and you will feel hungry again.
* Do not drink flavored beverages, even diet soda, between meals



Will I be allowed to drink alcohol?

You will find that even small amounts of alcohol will affect you quickly. Alcohol is high in calories and will significantly alter your calorie balance. It is suggested that you drink no alcohol for the first year. Thereafter, you may have a glass of wine or a small cocktail for social purpose not more than once a fortnight.

Will I need supplemental vitamins?

Most surgeons recommend a daily multivitamin for the rest of your life. Vitamin B12 injections are sometimes suggested once a month for the first year and every six months thereafter. It may also be taken orally or sublingually (under the tongue) by many patients.